The Diabetic Foot in End Stage Renal Disease

Παπάνας, Νικόλαος; Liakopoulos, Vassilios; Maltezos, Efstratios; Stefanidis, Ioannis

doi:10.1080/08860220701391662

Cited by 36 publications

(26 citation statements)

References 96 publications

(253 reference statements)

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“…Conversely, patients with diabetic nephropathy may exhibit more pronounced DSPN, and may therefore be at increased risk of severe diabetic foot lesions [147]. This information is important for the organization of an overall strategy for detecting, monitoring, and treating chronic microvascular complications.…”

Section: Nephropathymentioning

confidence: 99%

Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015

2015

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■ AbstractDistal symmetric sensorimotor polyneuropathy (DSPN) is the most common neurological manifestation in diabetes. Major risk factors of DSPN include diabetes duration, hyperglycemia, and age, followed by prediabetes, hypertension, dyslipidemia, and obesity. Height, smoking, insulin resistance, hypoinsulinemia, and others represent an additional risk. Importantly, hyperglycemia, hypertension, dyslipidemia, obesity, and smoking are modifiable. Stringent glycemic control has been shown to be effective in type 1, but not to the same extent in type 2 diabetes. Antilipidemic treatment, especially with fenofibrate, and multi-factorial intervention have produced encouraging results, but more experience is necessary. The major comorbidities of DSPN are depression, autonomic neuropathy, peripheral artery disease, cardiovascular disease, nephropathy, retinopathy, and medial arterial calcification. Knowledge of risk factors and comorbidities has the potential to enrich the therapeutic strategy in clinical practice as part of the overall medical care for patients with neuropathy. This article provides an updated overview of DSPN risk factors and comorbidities.

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Section: Nephropathymentioning

confidence: 99%

Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015

2015

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“…Our study showed frequency of nephropathy was 36.99% in patients undergoing diabetic foot amputation and it is comparable to 20 -30% of diabetic patients having nephropathy as shown by American diabetic care and Broumand B. 11,12 This indicated that worsening of kidney function would affect the treatment out come and prognosis of foot ulcers in patients with diabetic foot. It is very important to improve the kidney function in the treatment of patients with diabetic foot ulcers.…”

Section: Discussionmentioning

confidence: 54%

“…Rate of amputation is 6-10 times higher in patients with diabetic nephropathy as compare to general diabetic patients who do not have nephropathy. 12 There are many reports in literature on the risk factors for diabetic foot complications. However, little data is available on the risk factor especially nephropathy, for amputation in diabetic Foot.…”

Section: Introductionmentioning

confidence: 99%

Diabetic Foot Amputation; Frequency of Diabetic Nephropathy Among Patients

Akhtar¹,

Ahmed²,

Tabassum³

et al. 2017

TPMJ

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ABSTRACT… Introduction: Diabetic foot lesions have remained a major cause of morbidity in patients with kidney failure. Foot complications are more than twofolds in diabetic nephropathy patients, and the rate of amputation is 6 to 10 times higher in diabetic nephropathy patients in comparison to the general diabetic population. Objectives: To determine the frequency of diabetic nephropathy in patients undergoing diabetic foot amputation. Study Design: Observational cross-sectional study. Setting: Surgical Department Unit-II, Sheikh Zayed Medical College and Hospital Rahim Yar khan. Material and Methods: The duration of the study was 2 years from Dec-2013 to Dec-2015. A total number of 73 patients were included in this study. Patients who were admitted to the department of surgery for amputation of the foot or the leg having the history of diabetes regardless of their age and sex were selected for this study. Data analyses were carried out using SPSS Version17 software. Quantitative variables were presented as Mean and standard deviations. Frequency and percentages were computed for qualitative variables. Results: The mean age of the patients was 57.51±7.61 years. Out of 73 cases, there were 43(58.9%) males and 30 (41.1%) females. Previous history of amputation was observed in 26 (35.62%) cases, 48 (65.75%) patients were hypertensive. Out of 73 patients, Forty (54.79%) had controlled diabetes and 33 (45.21%) had uncontrolled diabetes. Twenty seven patients (36.99%) were diagnosed for diabetic nephropathy. The incidence of nephropathy was high in patients with advancing age. This incidence was in 26 (56.62%) patients with age 51 to 60 years and 18 (39.13%) in patients having age more than 60 years. Conclusions: Lower extremity amputations are strongly associated with nephropathy in diabetic patients. It is very important to check and improve the renal function in patients with diabetic foot ulcers who are hypertensive, increasing age and long duration of DM to prevent lower limb amputations. Key words:Diabetes mellitus (DM), Nephropathy, Diabetic foot amputation.

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“…Foot complications are more common in diabetic patients with ESRD,24 and in those undergoing dialysis 25. Diabetic patients are more likely to require amputation than non-diabetics on HD,26 are more likely to require more major amputation (below-knee or above-knee),27 and are more likely to die following amputation,28 percutaneous intervention29 or critical limb ischaemia 30.…”

Section: What Effect Does Diabetes Have On Mortality and Morbidity Inmentioning

confidence: 99%

Managing diabetes in dialysis patients

O'Toole¹,

Fan²,

Yaqoob³

et al. 2012

Postgraduate Medical Journal

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Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with dietitians and podiatrists.

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The Diabetic Foot in End Stage Renal Disease

Cited by 36 publications

References 96 publications

Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015

Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015

Diabetic Foot Amputation; Frequency of Diabetic Nephropathy Among Patients

Managing diabetes in dialysis patients

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